AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [14724]
|
Facility
|
OP
|
$39.88
|
|
Service Code
|
HCPCS J0290
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$21.97 |
Max. Negotiated Rate |
$39.88 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.08
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.07
|
Rate for Payer: Aetna of WY Medicare |
$26.32
|
Rate for Payer: Aetna of WY Medicare |
$26.31
|
Rate for Payer: Altius Auto/Workers Compensation |
$38.28
|
Rate for Payer: Altius Auto/Workers Compensation |
$38.28
|
Rate for Payer: Altius Commercial |
$38.28
|
Rate for Payer: Altius Commercial |
$38.28
|
Rate for Payer: Beech Street Commercial |
$39.07
|
Rate for Payer: Beech Street Commercial |
$39.08
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.74
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.73
|
Rate for Payer: Cash Price |
$27.91
|
Rate for Payer: Cash Price |
$27.92
|
Rate for Payer: ChoiceCare Network Commercial |
$38.68
|
Rate for Payer: ChoiceCare Network Commercial |
$38.67
|
Rate for Payer: Cigna of WY Commercial |
$39.07
|
Rate for Payer: Cigna of WY Commercial |
$39.08
|
Rate for Payer: Entrust Commercial |
$37.89
|
Rate for Payer: Entrust Commercial |
$37.88
|
Rate for Payer: First Choice Health Commercial |
$37.88
|
Rate for Payer: First Choice Health Commercial |
$37.89
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.88
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.89
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.13
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.12
|
Rate for Payer: HealthUtah PPO |
$39.87
|
Rate for Payer: HealthUtah PPO |
$39.88
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.67
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.68
|
Rate for Payer: Multiplan Medicare/VA |
$21.97
|
Rate for Payer: Multiplan Medicare/VA |
$21.97
|
Rate for Payer: One Health Plan of WY PPO |
$39.07
|
Rate for Payer: One Health Plan of WY PPO |
$39.08
|
Rate for Payer: PacificSource Commercial |
$35.89
|
Rate for Payer: PacificSource Commercial |
$35.88
|
Rate for Payer: PHCS PPO |
$39.07
|
Rate for Payer: PHCS PPO |
$39.08
|
Rate for Payer: Three Rivers PPO |
$29.90
|
Rate for Payer: Three Rivers PPO |
$29.91
|
Rate for Payer: TriWest Veterans Administration |
$23.13
|
Rate for Payer: TriWest Veterans Administration |
$23.12
|
Rate for Payer: United Healthcare Commercial |
$34.69
|
Rate for Payer: United Healthcare Commercial |
$34.70
|
Rate for Payer: United Healthcare Medicare |
$23.13
|
Rate for Payer: United Healthcare Medicare |
$23.12
|
Rate for Payer: WINHealth Partners Commercial |
$39.07
|
Rate for Payer: WINHealth Partners Commercial |
$39.08
|
Rate for Payer: Wise Provider Network Commercial |
$37.88
|
Rate for Payer: Wise Provider Network Commercial |
$37.89
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [14724]
|
Facility
|
IP
|
$39.88
|
|
Service Code
|
HCPCS J0290
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$25.00 |
Max. Negotiated Rate |
$39.88 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.08
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.07
|
Rate for Payer: Altius Auto/Workers Compensation |
$38.28
|
Rate for Payer: Altius Auto/Workers Compensation |
$38.28
|
Rate for Payer: Altius Commercial |
$38.28
|
Rate for Payer: Altius Commercial |
$38.28
|
Rate for Payer: Beech Street Commercial |
$39.08
|
Rate for Payer: Beech Street Commercial |
$39.07
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.73
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.74
|
Rate for Payer: Cash Price |
$27.92
|
Rate for Payer: Cash Price |
$27.91
|
Rate for Payer: ChoiceCare Network Commercial |
$38.67
|
Rate for Payer: ChoiceCare Network Commercial |
$38.68
|
Rate for Payer: Cigna of WY Commercial |
$39.08
|
Rate for Payer: Cigna of WY Commercial |
$39.07
|
Rate for Payer: Entrust Commercial |
$37.88
|
Rate for Payer: Entrust Commercial |
$37.89
|
Rate for Payer: First Choice Health Commercial |
$37.88
|
Rate for Payer: First Choice Health Commercial |
$37.89
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.88
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.89
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.32
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.31
|
Rate for Payer: HealthUtah PPO |
$39.88
|
Rate for Payer: HealthUtah PPO |
$39.87
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.67
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.68
|
Rate for Payer: Multiplan Medicare/VA |
$25.00
|
Rate for Payer: Multiplan Medicare/VA |
$25.00
|
Rate for Payer: One Health Plan of WY PPO |
$39.08
|
Rate for Payer: One Health Plan of WY PPO |
$39.07
|
Rate for Payer: PacificSource Commercial |
$35.89
|
Rate for Payer: PacificSource Commercial |
$35.88
|
Rate for Payer: PHCS PPO |
$39.07
|
Rate for Payer: PHCS PPO |
$39.08
|
Rate for Payer: Three Rivers PPO |
$29.90
|
Rate for Payer: Three Rivers PPO |
$29.91
|
Rate for Payer: TriWest Veterans Administration |
$26.32
|
Rate for Payer: TriWest Veterans Administration |
$26.31
|
Rate for Payer: United Healthcare Commercial |
$34.69
|
Rate for Payer: United Healthcare Commercial |
$34.70
|
Rate for Payer: United Healthcare Medicare |
$26.32
|
Rate for Payer: United Healthcare Medicare |
$26.31
|
Rate for Payer: WINHealth Partners Commercial |
$37.88
|
Rate for Payer: WINHealth Partners Commercial |
$37.89
|
Rate for Payer: Wise Provider Network Commercial |
$37.88
|
Rate for Payer: Wise Provider Network Commercial |
$37.89
|
|
AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$2.00
|
|
Service Code
|
HCPCS J0290
|
Hospital Charge Code |
J0290
|
Min. Negotiated Rate |
$0.85 |
Max. Negotiated Rate |
$2.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
Rate for Payer: Aetna of WY Medicare |
$1.00
|
Rate for Payer: Beech Street Commercial |
$1.90
|
Rate for Payer: Cash Price |
$1.40
|
Rate for Payer: Cash Price |
$1.40
|
Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
Rate for Payer: Cigna of WY Commercial |
$1.96
|
Rate for Payer: First Choice Health Commercial |
$1.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.00
|
Rate for Payer: HealthUtah PPO |
$2.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
Rate for Payer: Multiplan Medicare/VA |
$0.85
|
Rate for Payer: One Health Plan of WY PPO |
$1.96
|
Rate for Payer: PacificSource Commercial |
$1.80
|
Rate for Payer: PHCS PPO |
$1.90
|
Rate for Payer: Three Rivers PPO |
$1.50
|
Rate for Payer: TriWest Veterans Administration |
$1.00
|
Rate for Payer: United Healthcare Commercial |
$1.74
|
Rate for Payer: United Healthcare Medicare |
$1.00
|
Rate for Payer: WINHealth Partners Commercial |
$1.90
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [13513]
|
Facility
|
IP
|
$25.57
|
|
Service Code
|
HCPCS J0290
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$16.03 |
Max. Negotiated Rate |
$25.57 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.06
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.85
|
Rate for Payer: Altius Auto/Workers Compensation |
$24.55
|
Rate for Payer: Altius Auto/Workers Compensation |
$23.37
|
Rate for Payer: Altius Commercial |
$23.37
|
Rate for Payer: Altius Commercial |
$24.55
|
Rate for Payer: Beech Street Commercial |
$25.06
|
Rate for Payer: Beech Street Commercial |
$23.85
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.98
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.99
|
Rate for Payer: Cash Price |
$17.90
|
Rate for Payer: Cash Price |
$17.04
|
Rate for Payer: ChoiceCare Network Commercial |
$23.61
|
Rate for Payer: ChoiceCare Network Commercial |
$24.80
|
Rate for Payer: Cigna of WY Commercial |
$25.06
|
Rate for Payer: Cigna of WY Commercial |
$23.85
|
Rate for Payer: Entrust Commercial |
$23.12
|
Rate for Payer: Entrust Commercial |
$24.29
|
Rate for Payer: First Choice Health Commercial |
$23.12
|
Rate for Payer: First Choice Health Commercial |
$24.29
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.12
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.29
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.88
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.06
|
Rate for Payer: HealthUtah PPO |
$25.57
|
Rate for Payer: HealthUtah PPO |
$24.34
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.61
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.80
|
Rate for Payer: Multiplan Medicare/VA |
$16.03
|
Rate for Payer: Multiplan Medicare/VA |
$15.26
|
Rate for Payer: One Health Plan of WY PPO |
$25.06
|
Rate for Payer: One Health Plan of WY PPO |
$23.85
|
Rate for Payer: PacificSource Commercial |
$23.01
|
Rate for Payer: PacificSource Commercial |
$21.91
|
Rate for Payer: PHCS PPO |
$23.85
|
Rate for Payer: PHCS PPO |
$25.06
|
Rate for Payer: Three Rivers PPO |
$18.26
|
Rate for Payer: Three Rivers PPO |
$19.18
|
Rate for Payer: TriWest Veterans Administration |
$16.88
|
Rate for Payer: TriWest Veterans Administration |
$16.06
|
Rate for Payer: United Healthcare Commercial |
$21.18
|
Rate for Payer: United Healthcare Commercial |
$22.25
|
Rate for Payer: United Healthcare Medicare |
$16.88
|
Rate for Payer: United Healthcare Medicare |
$16.06
|
Rate for Payer: WINHealth Partners Commercial |
$23.12
|
Rate for Payer: WINHealth Partners Commercial |
$24.29
|
Rate for Payer: Wise Provider Network Commercial |
$23.12
|
Rate for Payer: Wise Provider Network Commercial |
$24.29
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [13513]
|
Facility
|
OP
|
$25.57
|
|
Service Code
|
HCPCS J0290
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.09 |
Max. Negotiated Rate |
$25.57 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.06
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.85
|
Rate for Payer: Aetna of WY Medicare |
$16.88
|
Rate for Payer: Aetna of WY Medicare |
$16.06
|
Rate for Payer: Altius Auto/Workers Compensation |
$23.37
|
Rate for Payer: Altius Auto/Workers Compensation |
$24.55
|
Rate for Payer: Altius Commercial |
$24.55
|
Rate for Payer: Altius Commercial |
$23.37
|
Rate for Payer: Beech Street Commercial |
$23.85
|
Rate for Payer: Beech Street Commercial |
$25.06
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.99
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.98
|
Rate for Payer: Cash Price |
$17.04
|
Rate for Payer: Cash Price |
$17.90
|
Rate for Payer: ChoiceCare Network Commercial |
$24.80
|
Rate for Payer: ChoiceCare Network Commercial |
$23.61
|
Rate for Payer: Cigna of WY Commercial |
$23.85
|
Rate for Payer: Cigna of WY Commercial |
$25.06
|
Rate for Payer: Entrust Commercial |
$24.29
|
Rate for Payer: Entrust Commercial |
$23.12
|
Rate for Payer: First Choice Health Commercial |
$23.12
|
Rate for Payer: First Choice Health Commercial |
$24.29
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.12
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.29
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.83
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.12
|
Rate for Payer: HealthUtah PPO |
$24.34
|
Rate for Payer: HealthUtah PPO |
$25.57
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.61
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.80
|
Rate for Payer: Multiplan Medicare/VA |
$14.09
|
Rate for Payer: Multiplan Medicare/VA |
$13.41
|
Rate for Payer: One Health Plan of WY PPO |
$23.85
|
Rate for Payer: One Health Plan of WY PPO |
$25.06
|
Rate for Payer: PacificSource Commercial |
$23.01
|
Rate for Payer: PacificSource Commercial |
$21.91
|
Rate for Payer: PHCS PPO |
$23.85
|
Rate for Payer: PHCS PPO |
$25.06
|
Rate for Payer: Three Rivers PPO |
$18.26
|
Rate for Payer: Three Rivers PPO |
$19.18
|
Rate for Payer: TriWest Veterans Administration |
$14.83
|
Rate for Payer: TriWest Veterans Administration |
$14.12
|
Rate for Payer: United Healthcare Commercial |
$21.18
|
Rate for Payer: United Healthcare Commercial |
$22.25
|
Rate for Payer: United Healthcare Medicare |
$14.83
|
Rate for Payer: United Healthcare Medicare |
$14.12
|
Rate for Payer: WINHealth Partners Commercial |
$23.85
|
Rate for Payer: WINHealth Partners Commercial |
$25.06
|
Rate for Payer: Wise Provider Network Commercial |
$23.12
|
Rate for Payer: Wise Provider Network Commercial |
$24.29
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [14372]
|
Facility
|
IP
|
$40.84
|
|
Service Code
|
HCPCS J0295
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$25.61 |
Max. Negotiated Rate |
$40.84 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.02
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.56
|
Rate for Payer: Altius Auto/Workers Compensation |
$39.21
|
Rate for Payer: Altius Auto/Workers Compensation |
$32.88
|
Rate for Payer: Altius Commercial |
$32.88
|
Rate for Payer: Altius Commercial |
$39.21
|
Rate for Payer: Beech Street Commercial |
$40.02
|
Rate for Payer: Beech Street Commercial |
$33.56
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.53
|
Rate for Payer: Cash Price |
$28.59
|
Rate for Payer: Cash Price |
$23.97
|
Rate for Payer: ChoiceCare Network Commercial |
$33.22
|
Rate for Payer: ChoiceCare Network Commercial |
$39.61
|
Rate for Payer: Cigna of WY Commercial |
$40.02
|
Rate for Payer: Cigna of WY Commercial |
$33.56
|
Rate for Payer: Entrust Commercial |
$32.54
|
Rate for Payer: Entrust Commercial |
$38.80
|
Rate for Payer: First Choice Health Commercial |
$32.54
|
Rate for Payer: First Choice Health Commercial |
$38.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.54
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.95
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.60
|
Rate for Payer: HealthUtah PPO |
$40.84
|
Rate for Payer: HealthUtah PPO |
$34.25
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.22
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.61
|
Rate for Payer: Multiplan Medicare/VA |
$25.61
|
Rate for Payer: Multiplan Medicare/VA |
$21.47
|
Rate for Payer: One Health Plan of WY PPO |
$40.02
|
Rate for Payer: One Health Plan of WY PPO |
$33.56
|
Rate for Payer: PacificSource Commercial |
$36.76
|
Rate for Payer: PacificSource Commercial |
$30.82
|
Rate for Payer: PHCS PPO |
$33.56
|
Rate for Payer: PHCS PPO |
$40.02
|
Rate for Payer: Three Rivers PPO |
$25.69
|
Rate for Payer: Three Rivers PPO |
$30.63
|
Rate for Payer: TriWest Veterans Administration |
$26.95
|
Rate for Payer: TriWest Veterans Administration |
$22.60
|
Rate for Payer: United Healthcare Commercial |
$29.80
|
Rate for Payer: United Healthcare Commercial |
$35.53
|
Rate for Payer: United Healthcare Medicare |
$26.95
|
Rate for Payer: United Healthcare Medicare |
$22.60
|
Rate for Payer: WINHealth Partners Commercial |
$32.54
|
Rate for Payer: WINHealth Partners Commercial |
$38.80
|
Rate for Payer: Wise Provider Network Commercial |
$32.54
|
Rate for Payer: Wise Provider Network Commercial |
$38.80
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [14372]
|
Facility
|
OP
|
$40.84
|
|
Service Code
|
HCPCS J0295
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$22.50 |
Max. Negotiated Rate |
$40.84 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.02
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.56
|
Rate for Payer: Aetna of WY Medicare |
$26.95
|
Rate for Payer: Aetna of WY Medicare |
$22.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$32.88
|
Rate for Payer: Altius Auto/Workers Compensation |
$39.21
|
Rate for Payer: Altius Commercial |
$39.21
|
Rate for Payer: Altius Commercial |
$32.88
|
Rate for Payer: Beech Street Commercial |
$33.56
|
Rate for Payer: Beech Street Commercial |
$40.02
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.53
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
Rate for Payer: Cash Price |
$23.97
|
Rate for Payer: Cash Price |
$28.59
|
Rate for Payer: ChoiceCare Network Commercial |
$39.61
|
Rate for Payer: ChoiceCare Network Commercial |
$33.22
|
Rate for Payer: Cigna of WY Commercial |
$33.56
|
Rate for Payer: Cigna of WY Commercial |
$40.02
|
Rate for Payer: Entrust Commercial |
$38.80
|
Rate for Payer: Entrust Commercial |
$32.54
|
Rate for Payer: First Choice Health Commercial |
$32.54
|
Rate for Payer: First Choice Health Commercial |
$38.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.54
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.69
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.86
|
Rate for Payer: HealthUtah PPO |
$34.25
|
Rate for Payer: HealthUtah PPO |
$40.84
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.22
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.61
|
Rate for Payer: Multiplan Medicare/VA |
$22.50
|
Rate for Payer: Multiplan Medicare/VA |
$18.87
|
Rate for Payer: One Health Plan of WY PPO |
$33.56
|
Rate for Payer: One Health Plan of WY PPO |
$40.02
|
Rate for Payer: PacificSource Commercial |
$36.76
|
Rate for Payer: PacificSource Commercial |
$30.82
|
Rate for Payer: PHCS PPO |
$33.56
|
Rate for Payer: PHCS PPO |
$40.02
|
Rate for Payer: Three Rivers PPO |
$25.69
|
Rate for Payer: Three Rivers PPO |
$30.63
|
Rate for Payer: TriWest Veterans Administration |
$23.69
|
Rate for Payer: TriWest Veterans Administration |
$19.86
|
Rate for Payer: United Healthcare Commercial |
$29.80
|
Rate for Payer: United Healthcare Commercial |
$35.53
|
Rate for Payer: United Healthcare Medicare |
$23.69
|
Rate for Payer: United Healthcare Medicare |
$19.86
|
Rate for Payer: WINHealth Partners Commercial |
$33.56
|
Rate for Payer: WINHealth Partners Commercial |
$40.02
|
Rate for Payer: Wise Provider Network Commercial |
$32.54
|
Rate for Payer: Wise Provider Network Commercial |
$38.80
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [11179]
|
Facility
|
IP
|
$54.88
|
|
Service Code
|
HCPCS J0295
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$34.41 |
Max. Negotiated Rate |
$54.88 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.78
|
Rate for Payer: Altius Auto/Workers Compensation |
$52.68
|
Rate for Payer: Altius Commercial |
$52.68
|
Rate for Payer: Beech Street Commercial |
$53.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.06
|
Rate for Payer: Cash Price |
$38.41
|
Rate for Payer: ChoiceCare Network Commercial |
$53.23
|
Rate for Payer: Cigna of WY Commercial |
$53.78
|
Rate for Payer: Entrust Commercial |
$52.14
|
Rate for Payer: First Choice Health Commercial |
$52.14
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.14
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.22
|
Rate for Payer: HealthUtah PPO |
$54.88
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.23
|
Rate for Payer: Multiplan Medicare/VA |
$34.41
|
Rate for Payer: One Health Plan of WY PPO |
$53.78
|
Rate for Payer: PacificSource Commercial |
$49.39
|
Rate for Payer: PHCS PPO |
$53.78
|
Rate for Payer: Three Rivers PPO |
$41.16
|
Rate for Payer: TriWest Veterans Administration |
$36.22
|
Rate for Payer: United Healthcare Commercial |
$47.75
|
Rate for Payer: United Healthcare Medicare |
$36.22
|
Rate for Payer: WINHealth Partners Commercial |
$52.14
|
Rate for Payer: Wise Provider Network Commercial |
$52.14
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [11179]
|
Facility
|
OP
|
$54.88
|
|
Service Code
|
HCPCS J0295
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$30.24 |
Max. Negotiated Rate |
$54.88 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.78
|
Rate for Payer: Aetna of WY Medicare |
$36.22
|
Rate for Payer: Altius Auto/Workers Compensation |
$52.68
|
Rate for Payer: Altius Commercial |
$52.68
|
Rate for Payer: Beech Street Commercial |
$53.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.06
|
Rate for Payer: Cash Price |
$38.41
|
Rate for Payer: ChoiceCare Network Commercial |
$53.23
|
Rate for Payer: Cigna of WY Commercial |
$53.78
|
Rate for Payer: Entrust Commercial |
$52.14
|
Rate for Payer: First Choice Health Commercial |
$52.14
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.14
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.83
|
Rate for Payer: HealthUtah PPO |
$54.88
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.23
|
Rate for Payer: Multiplan Medicare/VA |
$30.24
|
Rate for Payer: One Health Plan of WY PPO |
$53.78
|
Rate for Payer: PacificSource Commercial |
$49.39
|
Rate for Payer: PHCS PPO |
$53.78
|
Rate for Payer: Three Rivers PPO |
$41.16
|
Rate for Payer: TriWest Veterans Administration |
$31.83
|
Rate for Payer: United Healthcare Commercial |
$47.75
|
Rate for Payer: United Healthcare Medicare |
$31.83
|
Rate for Payer: WINHealth Partners Commercial |
$53.78
|
Rate for Payer: Wise Provider Network Commercial |
$52.14
|
|
AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$2,204.00
|
|
Service Code
|
HCPCS 27886
|
Hospital Charge Code |
27886
|
Min. Negotiated Rate |
$524.98 |
Max. Negotiated Rate |
$2,204.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,159.92
|
Rate for Payer: Aetna of WY Medicare |
$617.62
|
Rate for Payer: Beech Street Commercial |
$2,093.80
|
Rate for Payer: Cash Price |
$1,542.80
|
Rate for Payer: Cash Price |
$1,542.80
|
Rate for Payer: ChoiceCare Network Commercial |
$2,137.88
|
Rate for Payer: Cigna of WY Commercial |
$2,159.92
|
Rate for Payer: First Choice Health Commercial |
$1,983.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,093.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$617.62
|
Rate for Payer: HealthUtah PPO |
$2,204.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,137.88
|
Rate for Payer: Multiplan Medicare/VA |
$524.98
|
Rate for Payer: One Health Plan of WY PPO |
$2,159.92
|
Rate for Payer: PacificSource Commercial |
$1,983.60
|
Rate for Payer: PHCS PPO |
$2,093.80
|
Rate for Payer: Three Rivers PPO |
$1,653.00
|
Rate for Payer: TriWest Veterans Administration |
$617.62
|
Rate for Payer: United Healthcare Commercial |
$1,917.48
|
Rate for Payer: United Healthcare Medicare |
$617.62
|
Rate for Payer: WINHealth Partners Commercial |
$1,873.40
|
|
AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$2,204.00
|
|
Service Code
|
HCPCS 27886 AS
|
Hospital Charge Code |
27886
|
Min. Negotiated Rate |
$524.98 |
Max. Negotiated Rate |
$2,204.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,159.92
|
Rate for Payer: Aetna of WY Medicare |
$617.62
|
Rate for Payer: Beech Street Commercial |
$2,093.80
|
Rate for Payer: Cash Price |
$1,542.80
|
Rate for Payer: Cash Price |
$1,542.80
|
Rate for Payer: ChoiceCare Network Commercial |
$2,137.88
|
Rate for Payer: Cigna of WY Commercial |
$2,159.92
|
Rate for Payer: First Choice Health Commercial |
$1,983.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,093.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$617.62
|
Rate for Payer: HealthUtah PPO |
$2,204.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,137.88
|
Rate for Payer: Multiplan Medicare/VA |
$524.98
|
Rate for Payer: One Health Plan of WY PPO |
$2,159.92
|
Rate for Payer: PacificSource Commercial |
$1,983.60
|
Rate for Payer: PHCS PPO |
$2,093.80
|
Rate for Payer: Three Rivers PPO |
$1,653.00
|
Rate for Payer: TriWest Veterans Administration |
$617.62
|
Rate for Payer: United Healthcare Commercial |
$1,917.48
|
Rate for Payer: United Healthcare Medicare |
$617.62
|
Rate for Payer: WINHealth Partners Commercial |
$1,873.40
|
|
AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,658.00
|
|
Service Code
|
HCPCS 26910
|
Hospital Charge Code |
26910
|
Min. Negotiated Rate |
$633.28 |
Max. Negotiated Rate |
$2,658.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,604.84
|
Rate for Payer: Aetna of WY Medicare |
$745.04
|
Rate for Payer: Beech Street Commercial |
$2,525.10
|
Rate for Payer: Cash Price |
$1,860.60
|
Rate for Payer: Cash Price |
$1,860.60
|
Rate for Payer: ChoiceCare Network Commercial |
$2,578.26
|
Rate for Payer: Cigna of WY Commercial |
$2,604.84
|
Rate for Payer: First Choice Health Commercial |
$2,392.20
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,525.10
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.04
|
Rate for Payer: HealthUtah PPO |
$2,658.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,578.26
|
Rate for Payer: Multiplan Medicare/VA |
$633.28
|
Rate for Payer: One Health Plan of WY PPO |
$2,604.84
|
Rate for Payer: PacificSource Commercial |
$2,392.20
|
Rate for Payer: PHCS PPO |
$2,525.10
|
Rate for Payer: Three Rivers PPO |
$1,993.50
|
Rate for Payer: TriWest Veterans Administration |
$745.04
|
Rate for Payer: United Healthcare Commercial |
$2,312.46
|
Rate for Payer: United Healthcare Medicare |
$745.04
|
Rate for Payer: WINHealth Partners Commercial |
$2,259.30
|
|
AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,658.00
|
|
Service Code
|
HCPCS 26910 80
|
Hospital Charge Code |
26910
|
Min. Negotiated Rate |
$633.28 |
Max. Negotiated Rate |
$2,658.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,604.84
|
Rate for Payer: Aetna of WY Medicare |
$745.04
|
Rate for Payer: Beech Street Commercial |
$2,525.10
|
Rate for Payer: Cash Price |
$1,860.60
|
Rate for Payer: Cash Price |
$1,860.60
|
Rate for Payer: ChoiceCare Network Commercial |
$2,578.26
|
Rate for Payer: Cigna of WY Commercial |
$2,604.84
|
Rate for Payer: First Choice Health Commercial |
$2,392.20
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,525.10
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.04
|
Rate for Payer: HealthUtah PPO |
$2,658.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,578.26
|
Rate for Payer: Multiplan Medicare/VA |
$633.28
|
Rate for Payer: One Health Plan of WY PPO |
$2,604.84
|
Rate for Payer: PacificSource Commercial |
$2,392.20
|
Rate for Payer: PHCS PPO |
$2,525.10
|
Rate for Payer: Three Rivers PPO |
$1,993.50
|
Rate for Payer: TriWest Veterans Administration |
$745.04
|
Rate for Payer: United Healthcare Commercial |
$2,312.46
|
Rate for Payer: United Healthcare Medicare |
$745.04
|
Rate for Payer: WINHealth Partners Commercial |
$2,259.30
|
|
AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$2,637.00
|
|
Service Code
|
HCPCS 28800
|
Hospital Charge Code |
28800
|
Min. Negotiated Rate |
$434.79 |
Max. Negotiated Rate |
$2,637.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,584.26
|
Rate for Payer: Aetna of WY Medicare |
$511.52
|
Rate for Payer: Beech Street Commercial |
$2,505.15
|
Rate for Payer: Cash Price |
$1,845.90
|
Rate for Payer: Cash Price |
$1,845.90
|
Rate for Payer: ChoiceCare Network Commercial |
$2,557.89
|
Rate for Payer: Cigna of WY Commercial |
$2,584.26
|
Rate for Payer: First Choice Health Commercial |
$2,373.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,505.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$511.52
|
Rate for Payer: HealthUtah PPO |
$2,637.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,557.89
|
Rate for Payer: Multiplan Medicare/VA |
$434.79
|
Rate for Payer: One Health Plan of WY PPO |
$2,584.26
|
Rate for Payer: PacificSource Commercial |
$2,373.30
|
Rate for Payer: PHCS PPO |
$2,505.15
|
Rate for Payer: Three Rivers PPO |
$1,977.75
|
Rate for Payer: TriWest Veterans Administration |
$511.52
|
Rate for Payer: United Healthcare Commercial |
$2,294.19
|
Rate for Payer: United Healthcare Medicare |
$511.52
|
Rate for Payer: WINHealth Partners Commercial |
$2,241.45
|
|
AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$2,425.00
|
|
Service Code
|
HCPCS 28805 AS
|
Hospital Charge Code |
28805
|
Min. Negotiated Rate |
$577.67 |
Max. Negotiated Rate |
$2,425.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,376.50
|
Rate for Payer: Aetna of WY Medicare |
$679.61
|
Rate for Payer: Beech Street Commercial |
$2,303.75
|
Rate for Payer: Cash Price |
$1,697.50
|
Rate for Payer: Cash Price |
$1,697.50
|
Rate for Payer: ChoiceCare Network Commercial |
$2,352.25
|
Rate for Payer: Cigna of WY Commercial |
$2,376.50
|
Rate for Payer: First Choice Health Commercial |
$2,182.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,303.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$679.61
|
Rate for Payer: HealthUtah PPO |
$2,425.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,352.25
|
Rate for Payer: Multiplan Medicare/VA |
$577.67
|
Rate for Payer: One Health Plan of WY PPO |
$2,376.50
|
Rate for Payer: PacificSource Commercial |
$2,182.50
|
Rate for Payer: PHCS PPO |
$2,303.75
|
Rate for Payer: Three Rivers PPO |
$1,818.75
|
Rate for Payer: TriWest Veterans Administration |
$679.61
|
Rate for Payer: United Healthcare Commercial |
$2,109.75
|
Rate for Payer: United Healthcare Medicare |
$679.61
|
Rate for Payer: WINHealth Partners Commercial |
$2,061.25
|
|
AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$2,425.00
|
|
Service Code
|
HCPCS 28805
|
Hospital Charge Code |
28805
|
Min. Negotiated Rate |
$577.67 |
Max. Negotiated Rate |
$2,425.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,376.50
|
Rate for Payer: Aetna of WY Medicare |
$679.61
|
Rate for Payer: Beech Street Commercial |
$2,303.75
|
Rate for Payer: Cash Price |
$1,697.50
|
Rate for Payer: Cash Price |
$1,697.50
|
Rate for Payer: ChoiceCare Network Commercial |
$2,352.25
|
Rate for Payer: Cigna of WY Commercial |
$2,376.50
|
Rate for Payer: First Choice Health Commercial |
$2,182.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,303.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$679.61
|
Rate for Payer: HealthUtah PPO |
$2,425.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,352.25
|
Rate for Payer: Multiplan Medicare/VA |
$577.67
|
Rate for Payer: One Health Plan of WY PPO |
$2,376.50
|
Rate for Payer: PacificSource Commercial |
$2,182.50
|
Rate for Payer: PHCS PPO |
$2,303.75
|
Rate for Payer: Three Rivers PPO |
$1,818.75
|
Rate for Payer: TriWest Veterans Administration |
$679.61
|
Rate for Payer: United Healthcare Commercial |
$2,109.75
|
Rate for Payer: United Healthcare Medicare |
$679.61
|
Rate for Payer: WINHealth Partners Commercial |
$2,061.25
|
|
AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$2,425.00
|
|
Service Code
|
HCPCS 28805 80
|
Hospital Charge Code |
28805
|
Min. Negotiated Rate |
$577.67 |
Max. Negotiated Rate |
$2,425.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,376.50
|
Rate for Payer: Aetna of WY Medicare |
$679.61
|
Rate for Payer: Beech Street Commercial |
$2,303.75
|
Rate for Payer: Cash Price |
$1,697.50
|
Rate for Payer: Cash Price |
$1,697.50
|
Rate for Payer: ChoiceCare Network Commercial |
$2,352.25
|
Rate for Payer: Cigna of WY Commercial |
$2,376.50
|
Rate for Payer: First Choice Health Commercial |
$2,182.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,303.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$679.61
|
Rate for Payer: HealthUtah PPO |
$2,425.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,352.25
|
Rate for Payer: Multiplan Medicare/VA |
$577.67
|
Rate for Payer: One Health Plan of WY PPO |
$2,376.50
|
Rate for Payer: PacificSource Commercial |
$2,182.50
|
Rate for Payer: PHCS PPO |
$2,303.75
|
Rate for Payer: Three Rivers PPO |
$1,818.75
|
Rate for Payer: TriWest Veterans Administration |
$679.61
|
Rate for Payer: United Healthcare Commercial |
$2,109.75
|
Rate for Payer: United Healthcare Medicare |
$679.61
|
Rate for Payer: WINHealth Partners Commercial |
$2,061.25
|
|
AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$3,026.00
|
|
Service Code
|
HCPCS 27880 80
|
Hospital Charge Code |
27880
|
Min. Negotiated Rate |
$720.44 |
Max. Negotiated Rate |
$3,026.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,965.48
|
Rate for Payer: Aetna of WY Medicare |
$847.58
|
Rate for Payer: Beech Street Commercial |
$2,874.70
|
Rate for Payer: Cash Price |
$2,118.20
|
Rate for Payer: Cash Price |
$2,118.20
|
Rate for Payer: ChoiceCare Network Commercial |
$2,935.22
|
Rate for Payer: Cigna of WY Commercial |
$2,965.48
|
Rate for Payer: First Choice Health Commercial |
$2,723.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,874.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$847.58
|
Rate for Payer: HealthUtah PPO |
$3,026.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,935.22
|
Rate for Payer: Multiplan Medicare/VA |
$720.44
|
Rate for Payer: One Health Plan of WY PPO |
$2,965.48
|
Rate for Payer: PacificSource Commercial |
$2,723.40
|
Rate for Payer: PHCS PPO |
$2,874.70
|
Rate for Payer: Three Rivers PPO |
$2,269.50
|
Rate for Payer: TriWest Veterans Administration |
$847.58
|
Rate for Payer: United Healthcare Commercial |
$2,632.62
|
Rate for Payer: United Healthcare Medicare |
$847.58
|
Rate for Payer: WINHealth Partners Commercial |
$2,572.10
|
|
AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$3,026.00
|
|
Service Code
|
HCPCS 27880
|
Hospital Charge Code |
27880
|
Min. Negotiated Rate |
$720.44 |
Max. Negotiated Rate |
$3,026.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,965.48
|
Rate for Payer: Aetna of WY Medicare |
$847.58
|
Rate for Payer: Beech Street Commercial |
$2,874.70
|
Rate for Payer: Cash Price |
$2,118.20
|
Rate for Payer: Cash Price |
$2,118.20
|
Rate for Payer: ChoiceCare Network Commercial |
$2,935.22
|
Rate for Payer: Cigna of WY Commercial |
$2,965.48
|
Rate for Payer: First Choice Health Commercial |
$2,723.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,874.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$847.58
|
Rate for Payer: HealthUtah PPO |
$3,026.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,935.22
|
Rate for Payer: Multiplan Medicare/VA |
$720.44
|
Rate for Payer: One Health Plan of WY PPO |
$2,965.48
|
Rate for Payer: PacificSource Commercial |
$2,723.40
|
Rate for Payer: PHCS PPO |
$2,874.70
|
Rate for Payer: Three Rivers PPO |
$2,269.50
|
Rate for Payer: TriWest Veterans Administration |
$847.58
|
Rate for Payer: United Healthcare Commercial |
$2,632.62
|
Rate for Payer: United Healthcare Medicare |
$847.58
|
Rate for Payer: WINHealth Partners Commercial |
$2,572.10
|
|
AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$3,026.00
|
|
Service Code
|
HCPCS 27880 AS
|
Hospital Charge Code |
27880
|
Min. Negotiated Rate |
$720.44 |
Max. Negotiated Rate |
$3,026.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,965.48
|
Rate for Payer: Aetna of WY Medicare |
$847.58
|
Rate for Payer: Beech Street Commercial |
$2,874.70
|
Rate for Payer: Cash Price |
$2,118.20
|
Rate for Payer: Cash Price |
$2,118.20
|
Rate for Payer: ChoiceCare Network Commercial |
$2,935.22
|
Rate for Payer: Cigna of WY Commercial |
$2,965.48
|
Rate for Payer: First Choice Health Commercial |
$2,723.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,874.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$847.58
|
Rate for Payer: HealthUtah PPO |
$3,026.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,935.22
|
Rate for Payer: Multiplan Medicare/VA |
$720.44
|
Rate for Payer: One Health Plan of WY PPO |
$2,965.48
|
Rate for Payer: PacificSource Commercial |
$2,723.40
|
Rate for Payer: PHCS PPO |
$2,874.70
|
Rate for Payer: Three Rivers PPO |
$2,269.50
|
Rate for Payer: TriWest Veterans Administration |
$847.58
|
Rate for Payer: United Healthcare Commercial |
$2,632.62
|
Rate for Payer: United Healthcare Medicare |
$847.58
|
Rate for Payer: WINHealth Partners Commercial |
$2,572.10
|
|
AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$1,997.00
|
|
Service Code
|
HCPCS 27882 AS
|
Hospital Charge Code |
27882
|
Min. Negotiated Rate |
$475.14 |
Max. Negotiated Rate |
$1,997.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,957.06
|
Rate for Payer: Aetna of WY Medicare |
$558.99
|
Rate for Payer: Beech Street Commercial |
$1,897.15
|
Rate for Payer: Cash Price |
$1,397.90
|
Rate for Payer: Cash Price |
$1,397.90
|
Rate for Payer: ChoiceCare Network Commercial |
$1,937.09
|
Rate for Payer: Cigna of WY Commercial |
$1,957.06
|
Rate for Payer: First Choice Health Commercial |
$1,797.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,897.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$558.99
|
Rate for Payer: HealthUtah PPO |
$1,997.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,937.09
|
Rate for Payer: Multiplan Medicare/VA |
$475.14
|
Rate for Payer: One Health Plan of WY PPO |
$1,957.06
|
Rate for Payer: PacificSource Commercial |
$1,797.30
|
Rate for Payer: PHCS PPO |
$1,897.15
|
Rate for Payer: Three Rivers PPO |
$1,497.75
|
Rate for Payer: TriWest Veterans Administration |
$558.99
|
Rate for Payer: United Healthcare Commercial |
$1,737.39
|
Rate for Payer: United Healthcare Medicare |
$558.99
|
Rate for Payer: WINHealth Partners Commercial |
$1,697.45
|
|
AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$1,997.00
|
|
Service Code
|
HCPCS 27882
|
Hospital Charge Code |
27882
|
Min. Negotiated Rate |
$475.14 |
Max. Negotiated Rate |
$1,997.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,957.06
|
Rate for Payer: Aetna of WY Medicare |
$558.99
|
Rate for Payer: Beech Street Commercial |
$1,897.15
|
Rate for Payer: Cash Price |
$1,397.90
|
Rate for Payer: Cash Price |
$1,397.90
|
Rate for Payer: ChoiceCare Network Commercial |
$1,937.09
|
Rate for Payer: Cigna of WY Commercial |
$1,957.06
|
Rate for Payer: First Choice Health Commercial |
$1,797.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,897.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$558.99
|
Rate for Payer: HealthUtah PPO |
$1,997.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,937.09
|
Rate for Payer: Multiplan Medicare/VA |
$475.14
|
Rate for Payer: One Health Plan of WY PPO |
$1,957.06
|
Rate for Payer: PacificSource Commercial |
$1,797.30
|
Rate for Payer: PHCS PPO |
$1,897.15
|
Rate for Payer: Three Rivers PPO |
$1,497.75
|
Rate for Payer: TriWest Veterans Administration |
$558.99
|
Rate for Payer: United Healthcare Commercial |
$1,737.39
|
Rate for Payer: United Healthcare Medicare |
$558.99
|
Rate for Payer: WINHealth Partners Commercial |
$1,697.45
|
|
AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$1,997.00
|
|
Service Code
|
HCPCS 27882 80
|
Hospital Charge Code |
27882
|
Min. Negotiated Rate |
$475.14 |
Max. Negotiated Rate |
$1,997.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,957.06
|
Rate for Payer: Aetna of WY Medicare |
$558.99
|
Rate for Payer: Beech Street Commercial |
$1,897.15
|
Rate for Payer: Cash Price |
$1,397.90
|
Rate for Payer: Cash Price |
$1,397.90
|
Rate for Payer: ChoiceCare Network Commercial |
$1,937.09
|
Rate for Payer: Cigna of WY Commercial |
$1,957.06
|
Rate for Payer: First Choice Health Commercial |
$1,797.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,897.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$558.99
|
Rate for Payer: HealthUtah PPO |
$1,997.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,937.09
|
Rate for Payer: Multiplan Medicare/VA |
$475.14
|
Rate for Payer: One Health Plan of WY PPO |
$1,957.06
|
Rate for Payer: PacificSource Commercial |
$1,797.30
|
Rate for Payer: PHCS PPO |
$1,897.15
|
Rate for Payer: Three Rivers PPO |
$1,497.75
|
Rate for Payer: TriWest Veterans Administration |
$558.99
|
Rate for Payer: United Healthcare Commercial |
$1,737.39
|
Rate for Payer: United Healthcare Medicare |
$558.99
|
Rate for Payer: WINHealth Partners Commercial |
$1,697.45
|
|
AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,457.00
|
|
Service Code
|
HCPCS 28810
|
Hospital Charge Code |
28810
|
Min. Negotiated Rate |
$347.40 |
Max. Negotiated Rate |
$1,457.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,427.86
|
Rate for Payer: Aetna of WY Medicare |
$408.70
|
Rate for Payer: Beech Street Commercial |
$1,384.15
|
Rate for Payer: Cash Price |
$1,019.90
|
Rate for Payer: Cash Price |
$1,019.90
|
Rate for Payer: ChoiceCare Network Commercial |
$1,413.29
|
Rate for Payer: Cigna of WY Commercial |
$1,427.86
|
Rate for Payer: First Choice Health Commercial |
$1,311.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,384.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.70
|
Rate for Payer: HealthUtah PPO |
$1,457.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,413.29
|
Rate for Payer: Multiplan Medicare/VA |
$347.40
|
Rate for Payer: One Health Plan of WY PPO |
$1,427.86
|
Rate for Payer: PacificSource Commercial |
$1,311.30
|
Rate for Payer: PHCS PPO |
$1,384.15
|
Rate for Payer: Three Rivers PPO |
$1,092.75
|
Rate for Payer: TriWest Veterans Administration |
$408.70
|
Rate for Payer: United Healthcare Commercial |
$1,267.59
|
Rate for Payer: United Healthcare Medicare |
$408.70
|
Rate for Payer: WINHealth Partners Commercial |
$1,238.45
|
|
AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,457.00
|
|
Service Code
|
HCPCS 28810 80
|
Hospital Charge Code |
28810
|
Min. Negotiated Rate |
$347.40 |
Max. Negotiated Rate |
$1,457.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,427.86
|
Rate for Payer: Aetna of WY Medicare |
$408.70
|
Rate for Payer: Beech Street Commercial |
$1,384.15
|
Rate for Payer: Cash Price |
$1,019.90
|
Rate for Payer: Cash Price |
$1,019.90
|
Rate for Payer: ChoiceCare Network Commercial |
$1,413.29
|
Rate for Payer: Cigna of WY Commercial |
$1,427.86
|
Rate for Payer: First Choice Health Commercial |
$1,311.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,384.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.70
|
Rate for Payer: HealthUtah PPO |
$1,457.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,413.29
|
Rate for Payer: Multiplan Medicare/VA |
$347.40
|
Rate for Payer: One Health Plan of WY PPO |
$1,427.86
|
Rate for Payer: PacificSource Commercial |
$1,311.30
|
Rate for Payer: PHCS PPO |
$1,384.15
|
Rate for Payer: Three Rivers PPO |
$1,092.75
|
Rate for Payer: TriWest Veterans Administration |
$408.70
|
Rate for Payer: United Healthcare Commercial |
$1,267.59
|
Rate for Payer: United Healthcare Medicare |
$408.70
|
Rate for Payer: WINHealth Partners Commercial |
$1,238.45
|
|